Lecture 5 : Urinary organs and genital system and nutrition How to make urine Kidney capillary...
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Transcript of Lecture 5 : Urinary organs and genital system and nutrition How to make urine Kidney capillary...
Lecture 5 : Urinary organs and genital system and nutrition
How to make urine
Kidney
capillary
Glomerulus
Convoluted tubule
AdrenalCross section of left kidney
Urine tube
superior segmental artery
calices renales majores
Cortex
Arcuate artery
Small calyx
Meddula
Interlober artery
fibrous capsule
Renal sinus
Pelvis renalis
Back artery
Front under artery
Columnae renales
Under artery
Front upper artery
medullary ray
Clearance( C)
C = UV/P
U=Density of urine
V=Amount of urine a minute
P=Density of Plasma
A certain material shows whether only plasma ml how many was purified in one minute
Yasuo KAGAWA et al. “Core, molecular biology of human body” MARUZEN, 1997, p.286
It is filtere
d b
y th
e
glo
me
rulu
s,an
d p
art is
reab
so
rbe
d in
the
co
nv
olu
ted
tub
ule
It is filtere
d b
y th
e
glo
me
rulu
s, an
d if it is
Tm
or les
s, a
lmo
st
10
0% is
rea
bso
rbed
in
the c
on
volu
ted tu
bu
le.
Sec
retio
n fro
m d
ista
l
co
nv
olu
ted
tub
ule a
nd
se
t tub
e ch
iefly
Co
mp
letely
it ch
iefly
se
crete
s an
d it x
cre
tes
from
the
pro
xim
al
co
nv
olu
ted
tub
ule
Th
e g
lom
eru
lus
is
freely
pas
se
d, a
nd
it is
ex
crete
d in
urin
e as
it is
Pro
xim
ate H
en
le D
Ista
nt
Clearance, transport maximum, amount of renal blood flow, amount of glomerulus filtrationBecause the urinary output is about 1ml/minute, it is near U/P though the clearance of a cer
tain material shows whether the plasma of ml how many was purified in one minute. FF (filtration fraction) is a ratio of C of C/inulin of PAH. (about 20%)
Glu
co
se, A
min
o ac
id, V
itam
in (p
rox
ima
te)
Ren
al tu
bu
le
Inu
lin
So
diu
m
thio
su
lfate
(PA
H) p
-am
ino
hip
pu
ric a
cid
(PS
P) p
he
no
lsu
lfon
ph
tha
lein
Creatinine
Clearance is
About 100ml/min
Clearance
Glucose, Amino acid
Glucose
Amino acid
min
min Amount of plasma Amount of glomerulus filtration
Density of
urine
Density of plasma
Amount of
per minute
urine
minmin
Aboutn min ml/ min
Tm secretes Tm in re-absorption and PAH in the glucose
Den
sity in ren
al
blo
od
flow
Urea, creatin
ine, u
ric acid,
beta 2-m
icrog
lob
ulin
,
ph
osp
ho
ric acid
Closeup of glomerulus
It touches the arteriole that goes in and out to the glomerulus and there is a juxtaglomerular apparatus, and the renin is secreted according to the electrolyte and the blood pressure, and it controls the blood pressure
Bawman's capsule epithelial cell
Efferent arteriole
Afferent arterioles
Mesangial cell and Substrate
Proximal tubule cell
Glomerular epithelial cell
Glomerular basement
membrane
Glomerular endothelial cell
Juxtaglomerular apparatus
Granule
cell
Macula densa cell
Extraglomerular
mesangial cell
Water VitaminAmino acid
/energyElectrolyte
Monitoring of nutrient intake
Nourishment in vein and the monitor
GlucoseMetabolism
Trace element
Serum zinc(If it is
long-term TPN, even
copper and the
selenium are
acceptable. )
The chart of the body
fluid equilibrium and
the loss from urine
and fistula are
recorded
The capillary blood sugar
in urine every six hours
is measured in the ward
Serum and urine
inside density
and measurement
every week
one-twice
It is once every 1-2
weeks as for folic
acid and vitamin B12.
If the patient's
consumption
promotes it, vitamin C
and B1 also
Serum zinc (If it is
long-term TPN,
copper and the
selenium also)
It is a urea and an
electrolyte every day
until stabilizing. If 2-3
times and the
management every week
afterwards are difficult,
the electrolyte of urine
and other body
fluids is measured
Safety region of fluid infusion in kidney function normal person
GFR = 100 L/a dayUrine Dilution most 50mOsm/kg ・ H2OUrine Concentration most 1,000mOsm/kg ・ H2O
C y = 52050 - x
D y = 9001,000 - x
Safety region of fluid infusion
B xy = 1,360
A xy = 17
y (L/a day )
10
5
0500 1,000
x
(mOsm/kg ・ H2O)Density of osmotic pressure in fluid infusion
Tran
sfusio
n H
aca
Safety level of fluid infusion in senior citizen
GFR = 50 L/a dayUrine Dilution most 200mOsm/kg ・ H2OUrine Concentration most 700mOsm/kg ・ H2O
Tran
sfusio
n H
aca
y (L/a day )
10
5
0 500 1,000
Density of osmotic pressure in fluid infusion (mOsm/kg ・ H2O)
x
C′y = 580200 - x
D′y = 780700 - x
B′xy = 680
A′xy = 17
If the blood sugar level is controlled with meal and the number of haemoglobins A1c is decreased, a diabetic syndrome can be prevented occurring. However, 13,000 people a year introduce the dialysis now, and 260,000 total people keep dialyzing it by health benefits of 700,000 yen a person every month
Level of blood sugar control and kidney disease appearance of disease rate (DCCT research)
Rat
e o
f m
icro
alb
um
inu
ria
(Nu
mb
er o
f 10
0 /
a y
ear)
Kidney function classification by creatinine clearance (Ccr)
Kidney healthy Ccr 91ml/min or more
Kidney function slight decrease Ccr 71 ~ 90ml/min or more
Middle kidney function degree decrease Ccr 51 ~ 70ml/min or more
High degree of kidney function decrease Ccr 31 ~ 50ml/min or more
Renal failure period Ccr 11 ~ 30ml/min or more
Uremia period Ccr 10ml/min or more - Before dialyzing
Though passage to the chronic renal failure is classified based on ideas of Seldin at four
terms (the first stage (Nou preliminary decrease), the second stage (kidney function troub
le period), the third stage (renal failure period), and the fourth stage (uremia period)), the
place where it means a slight deterioration of renal function classifies the first stage and t
he second stage more in detail with a kidney function slight decrease, a middle degree d
ecrease, and an advanced decrease because it is large in actual clinical
Blood dialysis = kidney machine 270,000 dialysis patients, Dialysis cost of 600,000 yen a month,
Patient sudden increase
Vitamin E
Stream of blood
Stream of dialyzing fluid Oralalcorl
Polysulfone
Fluorine
Acrylic block
union
Treatment of renal failureTreatment of renal failure
Acute kidney disease
Chronic renal disease
Chronic renal failure
Blood dialysis
CAPDKidney transplant
recovery
recovery
Diabetic syndrome
Low
protein diet
Dialysis food
What is What is the blood dialysis treatment?the blood dialysis treatment?
Kidney machine
Blood
1. Remove the waste matter in blood
2. Remove Extra moisture
3. Adjust The density of the electrolyte (eg. Na,K,Ca)
4. Correct blood pH
Principle of blood dialysisPrinciple of blood dialysis
1. Diffusion phenomenon
Waste matter : Urea, Creatinine
Electrolyte : K(remove),Ca ・ Heavy carbonic acid (absorb)
Blood Dialyzing fluid
Blood Dialyzing fluid
◎ ◎◎
◎◎ ◎
× ×× ×
◎ ◎ ◎ ◎ ◎ ◎× × × ×
Dialysis membrane
Blood dialysis systemBlood dialysis system
Water-treating unit
Dialysis liquid supply deviceBed-side Monitor Dialyzer
Th
ick d
ialysis
liqu
id
Blood Pump
Heparin injection machine
Arm
Point of alimentary therapy (blood dialysis)Point of alimentary therapy (blood dialysis)
1.0 ~ 1.2g/kg/a day(Dialysis 3 times a week) 1.0g/kg/a day(Dialysis 2 times a week)Intake of good quality amino acid
ProteinProtein
・ Food with a lot of essential amino acids
・ Food with high score of amino acid and protein score
EnergyEnergy
35~ 40kcal/kg/a day fluency
Use of lipidYasuo KAGAWA. “Easy nourishment study” KAGAWA Nutrition publishing, 2006, p.144
NaNaWithin7~ 8g with Salt (within 120~ 137mEq)
At the edema and the high blood pressure complication: Within 5g. (85mEq or less)
Intake of waterIntake of waterKeeping from water
A weight increase during a day is within 0.7 - 1.0kg
Point of alimentary therapy(blood dialysis)Point of alimentary therapy(blood dialysis)
K K Within 2g/a day (within 50mEq/a day)
It doesn't take it too much. The vegetables, especially the root vegetable throw away the boiled soup
When there is a high potassium blood syndromeIt strongly limits it
P P Within 1000mg/a day (within 32mEq/a day)
It doesn't take it too much. The polyphosphoric acid such as the processed foods is avoided
When there is a high phosphorus blood syndromeIt limits it
Point of alimentary therapy(blood dialysis)Point of alimentary therapy(blood dialysis)
Ca Ca More than 600mg/a day (more then 15mEq/a day)
Be careful not to be lack of Ca
VitaminVitaminB group: It supplements because it is lost by the dialysis
because of the water solubilityC group: Normal range
A: Accumulation
D: VD replenishes revitalization type VD because it becomes a revitalization type by the kidney
Point of alimentary therapy(blood dialysis)Point of alimentary therapy(blood dialysis)
Balance of synthesis and excretion of uric acid
Into sweat and feces(200mg)
Into Urine(500mg)
Uric acid pool(1200mg)
NormalSynthetic amount / day(700mg)
Yasuo KAGAWA. “Easy nourishment study” KAGAWA Nutrition publishing, 2006, p.135-6
High uric acid blood syndrome
Drug therapy Drug therapy Drug therapy
Attacks of gout and coexisting illness
are none
Lifestyleguidance
Lifestyleguidance
Repetition of attacks of gout
There is a chalkstone
Non gouty attack,But have a
complication
Within 7-8mg/dL Within 7-9mg/dL
8mg/dL and more 9mg/dL or more
Fundamental ADL (activity of daily living)=Decrease in activity operation in daily life and the nursing
• Meal : Swallowing difficulty,Carved meal→PEG Walking : Articulatio genus pain →Wheelchair→Bedridden
Cloth : Operation decrease of finger, Cloth for nursing Bathing : Lost earlist→Bathing support systemExcretion : Especially, woman's QOL and pride are ruined Incontinence : Pelvis exercise → Wearing deaper Constipation : Food fiber, water→Purgative → Enema clyster Urinary retation : Needle prick to the bladder in the emergency
• The urethral catheterization and the enema clyster are law revision to make it do in case of no nursing master
They are three stages of the character decision, and, moreover, social differences
Sex determinating gene SRY=Sex-determining Region of Chromosome Y makes the indifferent gonad a testicle, changes the brain to the man by the androgen shower, and makes the vesicular gland, the prostate, and the penis. Making the brain a nature becomes trouble and a gender identity disorder. It is a woman if there is no SRY
Estrogen
Androgen
First step Second step Third step
Ovary
Testicle
Meiosis
Undifferentiation gonad
Immature ovum
maturity ovum
Maturity semen
Inherited decision of sex chromosome
X-Y Antigen
Yasuo KAGAWA et at al. “Core, molecular biology of human body” MARUZEN, 1997, p.186
First sex determination by SRY antigen
2nd sex determinationby sex hormone
(1st polar body)(2nd polar body)
male
female
Male genitalia and hormoneThe dilation of the prostate is diagnosed by the rectal examination and the supersonic wave.
The bladder is looked after with the bladder mirror
Glans
Urethra(24cm)
Penis
Anus
PubisDeferent
canal Bladder
Testicle : Secretion of sperm formation and male hormone
Amount of semen
Number of semen
Seminal vesicle(prostaglandin)
Prostate
Biochemistry of male function
1. XY chromosome (Sex choromosome)2. Pituitary hormone (FSH, LH)3. Androgen (C19 Steroid)4. Others (LHRH, Prostaglandin)
Cunt and character hormone
The make an internal examination and the vaginal retractor speculum of the examination on the make an internal examination stand. The virgin is a rectal examination. The bladder is a bladder mirror.
Anus
Vagina
Labia majora
Labia minor
Clitoris
Ovary
Ovum formationFollicle hormone
secretionProgestin secretion
Urethra(4cm)
Pubis
Urinary bladder
WombEmbryo's
growth
1. XX chromosome (Sex choromosome)2. Pituitary hormone (FSH, LH, PRL)3. Estrogen (C18 Steroid)4. Progesterone (C21 Steroid)5. Placental hormone (HCG, other)6. Others (LHRL etc)
Biochemistry of female function
Menstrual cycle and female hormone
The functional layer of the endometrium is lost by the yellow body degeneration if the ovulation happens by the LH serge (rapid decrease of the yellow body making hormone), and there is no conception
LH sergeCorpora lutea degeneration
Hypothalamus↓
Pituitary body
Inhibin
Placenta
Yasuo KAGAWA et at al. “Core, molecular biology of human body” MARUZEN, 1997, p.190 anterior pituitary
gland posterior pituitary
gland
prolactin
ovarian follicle ovarian follicleIs mature
luteinizing hormone
follicle-stimulating hormone
progesterone
progesterone
Progesterone(from corpus luteum ) p
rog
es
tero
ne
es
tra
dio
l
Basal lamina
Functionallayer
menstruating follicular phase ovulation luteal phase
estradiol
Placentalactogen
corpus luteum
growth
hypothalamus
Pro
ges
teron
e
chorionic gonadotropin
Va
gin
a m
uc
os
a
hypophyseal portal
milk ejection oxytocin
release
Mammary
growth
Glyco
gen
synth
esis
Vag
ina self p
urificatio
n
end
om
etria
corpus luteum degeneration
Intimal development
day
s
lutein
ization
egg
Fertilization and
arrival floor
The ovum fertilized in the oviduct gets off in the endometrium while doing the cleavage and is an arrival floor
Transparent body
Ovulation
Implantation
Hydatidiform mole
Perivitelline space
Endometrium that acted progestin
Nuclear fusion period
BlastulationA man pronucleus that is divided
to 2 pieces
Fertilization
A female pronucleus
A female pronucleus
A male pronucleus
A male pronucleus
Sperm tail Mulberry real embryo
Yasuo KAGAWA et at al. “Core, molecular biology of human body” MARUZEN, 1997, p.192
SemenYolk
Yolk
First polar body